The lima success story--whither other arterial grafts--are vein grafts obsolete?

The long-term benefit of myocardial revascularisation depends largely upon the continued patency of bypass grafts, but the long-term patency of vein grafts is poor. To improve the results of myocardial revascularisation, either measures to increase the patency of saphenous vein grafts or alternative conduits are required. Use of the left internal mammary artery as a graft is known to increase survival, and this has prompted wider use of other arterial grafts in the expectation that they will further enhance the long-term results of coronary artery bypass. This policy is based upon sound theory, but convincing evidence that it improves survival is lacking. Meanwhile, advances in the understanding of the pathology of vein graft occlusion have given rise to new methods of increasing vein graft patency. While these techniques are, as yet, only experimental, if translated into clinical practice, the places of arterial and venous grafts may require further assessment.